Prognostication after cardiac arrest

Claudio Sandroni*, Sonia D'Arrigo, Jerry P. Nolan

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

64 Citations (Scopus)
369 Downloads (Pure)


Hypoxic-ischaemic brain injury (HIBI) is the main cause of death in patients who are comatose after resuscitation from cardiac arrest. A poor neurological outcome-defined as death from neurological cause, persistent vegetative state, or severe neurological disability-can be predicted in these patients by assessing the severity of HIBI. The most commonly used indicators of severe HIBI include bilateral absence of corneal and pupillary reflexes, bilateral absence of N2O waves of short-latency somatosensory evoked potentials, high blood concentrations of neuron specific enolase, unfavourable patterns on electroencephalogram, and signs of diffuse HIBI on computed tomography or magnetic resonance imaging of the brain. Current guidelines recommend performing prognostication no earlier than 72 h after return of spontaneous circulation in all comatose patients with an absent or extensor motor response to pain, after having excluded confounders such as residual sedation that may interfere with clinical examination. A multimodal approach combining multiple prognostication tests is recommended so that the risk of a falsely pessimistic prediction is minimised.

Original languageEnglish
Article number150
Number of pages9
JournalCritical Care
Publication statusPublished - 5 Jun 2018


  • Cardiac arrest
  • Coma
  • Hypoxic brain damage
  • Prognosis

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